Hilum overlay sign

Case contributed by Stefan Tigges
Diagnosis almost certain

Presentation

Cough.

Patient Data

Age: 60 years
Gender: Male
x-ray

Left-sided mass with "hilum overlay" sign, minimal left basilar atelectasis.

Annotated image

The red arrowheads show normal hilar structures visible through the mass (blue arrows).

ct

Anterior mediastinal mass, dependent atelectasis.

Case Discussion

The right hilum is visible through the anterior mediastinal mass on the chest X-ray, a finding known as the "hilum overlay" sign. This sign indicates that the mass is either anterior or posterior to the hilum. If a mass is within the hilum, then the soft tissue density mass and the soft tissue density hilum are indistinguishable on X-ray, and the hilum is obscured. 

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